22 April 2011

Sometimes Dr Grumble feels embarrassed when he sits in his clinic in shirt sleeves and a well-dressed patient comes in. Starched white coats are a thing of the past. The evidence is that patients do not worry too much about how their doctor is dressed but if a patient takes the trouble to look smart it can feel awkward. Infection control is not really an issue in the Grumble clinic but our managers don't think that way so, like our Prime Minister, Dr Grumble dresses down.

Yesterday an elderly man can into the clinic. Elderly people sometimes appear to dress up to see the doctor. This man, despite being retired, was dressed unusually smartly. His son who came with him was dressed more casually. Dr Grumble's heart sank a little when he saw the son. The patient had a foreign name. Sometimes younger relatives come to translate. It always takes longer and the history is never quite as good. The referral letter said very little about the patient. There was certainly no mention of a language problem.

As Dr Grumble began to take his history he recognised that there was something a bit special about his patient. His English was impeccable. A few clues suggested that he might be a doctor. He quickly flicked through the notes to check if somebody had had the courtesy to alert Grumble as to this educated man's profession but there was nothing. Grumble listened intently and tried to tease out the diagnosis with carefully directed questions. Then he came to the social bits. Where was the patient from? What had been his job? It turned out that he was a retired surgeon from Iraq - a professor no less. Dr Grumble asked him for his views on the war. You can guess the answer. And then a story unfolded. At the time of the war Grumble's patient was already retired. But surgeons never really retire. If there is a crisis you may have a duty to help and so it was with Grumble's patient. As the battle raged the hospital telephoned the retired surgeon asking urgently for his help. They couldn't cope with the number of wounded and they needed all the surgeons they could get. Patients were bleeding to death and they had little blood. Grumble's patient leapt in his car and headed for the hospital as quickly as he could. The streets were dangerous. There was fighting. But, as a doctor, you have a duty to help even if it means putting yourself at risk. And that's what Grumble's patient did. He raced through the streets eager to return to work and do what he could. He drove as fast as he could down the familiar route to the hospital going the way he had gone countless times before. Then, as he rounded a bend, all of a sudden his windscreen shattered and he was struck in the head by a bullet. Still conscious he grabbed his white coat from the back seat and wave it out of the window. Whether this was seen as surrender or a badge of office is unclear but the firing stopped. Grumble's patient had been shot at by the Americans. Blood was streaming down his face and he asked the soldiers for a medic to help him. But they took no notice and waved him on. Later he counted 16 bullet holes in his car.

You might think that in war soldiers would have a duty to help the wounded whichever side they are on. Apparently not. Not the Americans anyway. Doctors are different. Whatever you think of your patient you must help. Friend or enemy, it doesn't matter. You have a duty to your patients whoever they are and whatever their cause.

If, for example, you happen to be a doctor in Bahrain you have an inalienable duty to help the wounded whether they are protesters against the government or on the side of the government. Those are the rules that every doctor must follow. It is an essential fundamental rule. Doctors must be trusted by patients everywhere whoever they are and whatever their beliefs. So if a government takes the view that doctors are helping protesters by treating them and decides to lock up doctors, this is a particularly evil act. Which makes the government of Bahrain look pretty evil to Dr Grumble - especially if it is true that surgeons are being dragged out of operating theatres while treating protesters. So why does our shirt-sleeved prime minister not do something about it? Or would that mean yet another useless war? Or could it be that there is one rule for Libya and another for states close to Saudi Arabia?

2 comments:

With regards to dress, infection control does seem to take it a little too far. For example a fellow student of mine in an attempt to look more formal for the surgeons on a new rotation decided to wear a smart silk tie. This tie, hanging out became an issue of contention with one nurse who commanded them to either remove it or tuck it into his shirt.

In response the student pointed out the nurses ID badge dangling from her neck at roughly the same level. Drawing comparisons didn't help his cause - the nurse refused to accept it was the same and he swiftly removed his tie following threats of being reported.